LAND USE R Application# 1 ✓'�O Cf V 1�.
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InXlal ADpliretim Date: CU& -
A last
iffy OF HARNETT RESIDENTIAL LAND USE APPLICATION
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Central Permitting 108 E.Front heet.UEkglon,NC 27548 Phone:(910)893.7525 exl:2 Far(910)893-2793 www.ham.t1 OW/PermIY
"A RECORDED SSURVEYYAP,RECORDED DEEDI (OR OPFER TO PURCHASE)&SITE PIAN ARE REQUIRED WHEN SUBMITTING A LAND USE APPLICATION"
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LANDOWNER \&Y `�`C`C \ DDORAMilling Addm :H W+Arb1 v' FL18c
City:
Stale: ZipZ� l Contact No: Y1 `"��14 EmaN:
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APPLICANT': MaiNng Address:
Zi Contact No: Email:
D Slate: Zip_
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m outaP(bnl IMormelbn Xdifferent clan Yr,tlowrar
A► s � Phone#
CONTACT NAME APPLYING IN OFFICE: el • �r._ /� /'
(,»#: an- Lot Size: /�1% ISTC
PROPERTY LOCATION:Subdivision: - �, - Map Book 8 Pepe: . La ' a �r�
State Road& I State�R(oaadd Name: ac. A ^ ap a� • C\ _ ' —.7V
Pamel: °Li e b(D -1 00Ra V- PIN: 0 C t —let l
Zoning: Flood Zone: Watershed: IT,�']1 Deed Book&Page:357 1 Z OQ byower Comfy from Progress Energy.
'New structures with Progress Energy as service provider need to supply premise number
PROPOSED USE:
/�i A/ r� Monolithic
(Sita.X CT 1)#Bedrooms Baths:_Basemen)w6 o beth):K Garage: Deck:_Crawl Space:) ..Slab:_Stab:_
(Is the bonus room finished?(_)yes ( )no vet a closet?(_)yes (__)co(I yes add in with#bedrooms)
O Mod:(Size x_)#Bedrooms_#Baths_Basement(wMvo bath) Garage: Site Built Deck:_ On Frame_Off Fane_
(Is the second floor finished?( )yes (_)no My other site built additions?(_)yes (_)no
)#Bedrooms:_Garage:_(sile built?_)Deck: (site built?_)
CI Manufactured Home'._SW_DW TW(Size__x
❑ Duplex:(Size x—)No.Buildings:
No.Bedrooms Per Unit:
❑ Home Opoupalian:it Rooms: Use:
Hours of Operation: #Employees'.
Closets in addition?U yes (—)no
O Addition/Accessory/Other(Shea_x_)Use:
Water Supply: _County -_Existing Well _New Well(#of dwellings using well )'Mual have operable water before final
Sewage Supply:_New Septic Tank(Complete Checklist) _Existing Septic Tank(Complete Checklist) County Sewer
Does owner of this tract of land,own land that contains a manufactured home within five hundred feet(500')of tract listed above?( )yes L)no
Does the properly contain any easements whether underground or overhead L)yes (_)no
iVuquros(existing or proposed):Single family tlwelNrgs: \,,,...9.. .
-�
Manufactured Homes: Other(specify):
PXi��-,rcn ,, Q . he.,+�
tequlretl RerldeatW Property Line Setbacks: Co✓nimeuls: JJ
MM Minimum_ Actual ' 0 PV)AV \-\--
tear
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mo_ _ 1
:ear p 9'], CjA-n't'--tc . f\) Lt.A\ /V.P.� l I(tc�L.4,1 (i
tosest Side
idestreot/conor lot �L
barest Building — 03111
1 same lel page 1 of 2
Residential Land Use Application APPLICATION CONTINUES ON BACK
•
SPECIFIC DIRECTIONS TO THE PROPERTY FROM L./LLINGTON: ••
If permits are granted I agree nn b aN ordinan -of the Slate of
I hereby state that foregoing re a •. rate a -CarolinaP vnit sitirp such work and the ha Mformana of• the Leat of • -..e. PertnileG ,YW Non6plans submitted.
.,i / /( /� fahe Mdormalbnis provided.
Signature of Owner or Owner's •
Date
"'S Is the owner/applicants responsibility to provide the county with any applicable information about the subject property.Including but not limited
to:boundary information,house location,underground or overhead easements,etc.The county or Its employees are not responsible for any
Incorrect or pissing Information that is contained within the..appliations.•"
"This application expires 6 months from the Initial date R pemats have not been Issued"
•
Residential Land Use Appliafon
Page 2 o 2
03/11
Harnett County Department of Public Health
Well Construction Permit Application
if the information in the application for a Well Construction Permit is falsified,
changed, or the site is altered, then the Well Construction Permit shall become
invalid.
APPLICANT INFORMATION
(oD7 )
1••0 a tlk • "J Phone Number
Ap•I•anttTvner •_ a - L 11 -
Street Address,City,State,Zip Code
The Applicant must submit a Site Plass. The Site Plan Iso map/drawing of the property and must show:
I.existing end/or proposed property lines and easements with dimensions;
2.the location of the facility and appurtenance;
3. the location for the proposed well;
4.the location of existing or proposed sewer lines and/or sewage disposal systems within 100 feet or the proposed well;
5.the location of any existing wells within 100 feet of the property;surface water bodies;
6,above ground and/or underground storage tanks; well site.
7. and any other known sources of contamination within 100 feet of the proposed
The Applicant shall notify the Harnett County Health Director through or by way of the Harnett County
Division of Environmental Health if any of the following occur prior to well construction:
1.there is a relocation of the proposed facility;
2.there is a change in the intended use of the facility;
3.there is a need for installjng the waste water system in an area other than indicated on the well pemlit;or
4.them are landscape changed that affect site drainage.
Contact information: Environmental Health Division-910-893-7547
PROPERTY INFORMATION
,'Proposed use of well
Single-Famil Multifamily❑ Church 0 Restaurant 3 Business ❑ Irrigation D
L
Street Address • \u- S- c\ _ _s Subdivision/Lot#131kh�S _fy1T L\c"
Parcel# OHO to to { 000‘a - PIN# O In GV-12.3 00 O
Directions to the Site
I have thoroughly read and completed this Application and certify that the Informatnn provided herein is true,complete and
correct lo the best of my knowledge and Is give in good faith. Representatives of the Harnett County Health Department and
state officials are granted right of entry to conduct necessary inspections to determine compliant with applicable rules.
I undepf<nd that s•m solely responsible for the proper identicanon and labeling fall property lines,underground wally lima and
making the si sible so that a wil(. constructed according t he permit /
nnof
72
Property Owner's or Owner's Legal Representative Si pure Required
Date
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a WM. GREGORY
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50127°E 213.23'
SITE PLAN APPROVAL `
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